Provider Demographics
NPI:1477632727
Name:THOMAS, STEVEN ALLEN (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ALLEN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 ALLEGHANY
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3833
Mailing Address - Country:US
Mailing Address - Phone:847-223-7028
Mailing Address - Fax:
Practice Address - Street 1:1ST AVENUE, ONE BLOCK NORTH OF CERMAK
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-786-4920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist